Don't just Pop Morning-after Pills

It is a convenient way to avoid pregnancy if you had unprotected sex the last night. Ever since the morning–after pills or emergency contraceptive (EC) pills were made available over–the–counter (OTC) in India, gynaecologists say, it is being misused. A majority of women, especially unmarried, are using it as a substitute for regular contraceptive methods.

“The Indian society is changing. One–nightstands are very common, and the easiest way to avoid unexpected pregnancy is through these emergency contraceptive pills. Married women still use some sort of regular contraceptives, but it is the unmarried lot, who rely on these morning–after pills. They little realise the underlying danger of overuse of this drug,” says Asha Sharma, HoD, gynaecology, Rockland Hospital.

Earlier, women who had unprotected sex, had to consult a gynaecologist for EC, as it was given only on prescription. But after it was made an OTC, the sales have gone up. “The sale of emergency contraceptives has definitely gone up in the past few years. We don’t check the age of a woman or ask for prescription when she demands an EC. As a result, often EC is sold to young girls,” says a chemist.

Unaware of the serious consequences, most women take about three–five pills per menstrual cycle. The most common problem is delayed menstrual cycle, which increases the risk of having an unwanted pregnancy. Though the failure rate of emergency contraceptive is about 1–2%, in some cases women come to know about the pregnancy in the advance stages. The pill has high doses of progestins levonorgestral that interferes with the fertilisation process. In some cases, women suffer from withdrawal bleeding due to shedding of endometrial lining. Some get mild spotting which they mistake it as regular menstrual cycle.

“As a result, women don’t come to know when they have actually missed their periods. Most women come to us when they miss their second cycle and most cases are in advance stages of pregnancy,” says Anuradha Kapoor, senior consultant gynaecologist, Max Healthcare.

The timing of the pill is very important. Though it is said that it can be taken within 72 hours of unprotected sex, its efficacy drops to 60% if taken after 24 hours. “One should try and take the pill within 24 hours of unprotected sex. But if the implantation has taken place, then the pill wouldn’t be effective. But efficacy of emergency contraceptive pills is less than regular contraceptives. And the failure rates keep adding, thereby increasing the chances of future pregnancies,” says Suneeta Mittal, HoD, gynaecology, AIIMS.

The EC can delay the ovulation (prevent eggs from being released from the ovaries), prevent fertilisation or prevent implantation of fertilised egg in the uterus. It all depends on the menstrual cycle of a woman. “If it is post–ovulation then it might prevent fertilisation or implantation. But in cases, where the emergency contraceptive fails to prevent pregnancy, the risks are high as it could lead to ectopic pregnancy. That could be serious,” says Mala Srivastava, senior consultant, gynaecologist, Sir Ganga Ram Hospital.

Doctors insist that women must see a gynaecologist after using EC, as changes of ectopic pregnancy or advance stage pregnancy could be ruled out. Moreover, women who conceive despite using EC have no other option but to go for medical termination of pregnancy (MTP). “The only way to avoid all these complications is to judiciously use emergency contraceptive pills. Though the side effects of emergency contraceptive pills are not much, it could in some cases result in serious complications,” cautions Sharma.

There are two types of emergency pills: progestin–only and a combination of estrogen and progestin. Doctors say, progestin only are safer and much more effective. Available just for Rs 25, EC is fast becoming a preferred option by sexually active women and young girls.

After 72 hours it is not effective. Also, it is not effective in cases where implantation has already happened.

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